Beyond the ASRM transfer guidelines: maximum number of embryos to transfer in women ≥ 43 years of age

Abstract

To determine the maximum number of cleavage stage embryos that can be safely transferred in women ≥43 years old. Retrospective cohort. Cycles from 1/2004-4/2012 were reviewed for transfer of ≥5 day 3 embryos. Donor egg cycles were excluded. Implantation, clinical pregnancy, live birth, rate of twins, and rate of higher order multiples (HOM) were analyzed, stratifying by age and number of embryos transferred. Differences between groups were assessed via ANOVA with Bonferroni adjustment, where p<0.05 was considered significant. 561 patients ages 43-45 were identified whose IVF cycles were characterized by transfer of 5-8 cleavage stage embryos. No patient had more than 8 embryos transferred. 45 year old patients exhibited higher day 3 FSH than 43 year old patients. There were otherwise no demographic differences between ages. Each age group had experienced an average of 3 prior IVF failures. 2/66 (3%) of pregnancies in 43 year olds were triplet gestations, one of which selectively reduced to twins, and the other spontaneously reduced to twins. Twin birth was 11.7%, 6.8%, and 0% for ages 43, 44, and 45, respectively. There were no HOM births.Tabled 1Clinical outcomes for patients ≥43 undergoing transfer with ≥5 embryosAge 43# of Embryos5678n =151129126Implantation7.9%7.0%7.0%6.3%Live birth11.9%16.3%16.7%33.3%Twin FH23.5%23.3%0%50%Triplet FH2.9%3.3%0%0%% Twin Birth22.2%9.5%0%50%Age 44n =9278166Implantation4.4%5.6%0.9%4.2%Live birth10.9%7.7%6.3%16.7%Twin FH0%14.3%0%0%Triplet FH0%0%0%0%% Twin Birth0%16.7%0%0% Open table in a new tab Transferring as many as 8 cleavage-stage embryos can be viewed as a safe option for IVF patients ≥43 years of age with multiple prior failures.